Medicare Parts A, B, and D
Medicare is a federally-funded health insurance program. Typically it serves as the primary insurance for people over age 65, as well as for people with certain disabilities or health conditions. Medicare generally covers 80% of outpatient services (medical services provided in the community) and all hospitalizations (minus a deductible).
Medicare has three parts, Part A, B and D. There is another program under Medicare Part C, which is now called Medicare Advantage (formerly Medicare Choice).
Medicare Part A covers inpatient hospital care, skilled nursing facility care, home health care and hospice care. Most people do not pay a monthly premium for Part A because either they or their spouse paid Medicare taxes through previous employment earnings. Part A has deductibles and co-payments, which the patient is responsible for paying during each benefit period. A benefit period begins when you are admitted to the hospital or skilled nursing facility and ends when you are discharged, and 60 consecutive days have passed.
Medicare Part B covers medical care and services provided by physicians, durable medical equipment and a variety of outpatient care services. Each year, the beneficiary must pay the first $100 in approved medical charges before Part B starts to pay, in addition to the regular monthly premium.
Frequently Asked Questions:
Who is eligible for Medicare benefits?
Persons 65 or older who are entitled to Social Security or Railroad Retirement
benefits; persons under 65 who have been entitled to Security Disability
Insurance benefits or Railroad Retirement Disability benefits for 24 months;
and persons of any age who have end-stage renal disease.
Is there any limit on income and resources?
No, Medicare has no limit on income and resources. By comparison, Medicaid
is needs based and so qualification for Medicaid depends upon income and
resources, among other eligibility requirements.
Is US citizenship required?
All Medicare applicants must be either US citizens or legally present aliens
who have had continuous residence in the United States for at least 5 years.
Where can I apply for Medicare?
You can get additional information or apply for Medicare, through the Social
Security Administration at 1-800-772-1213, or visit online at www.medicare.gov or www.ssa.gov.
What documentation will be required when applying?
You will need proof of age, such as a birth certificate, baptism certificate,
etc., with proof of citizenship or lawful entry into the U.S. and Social
Security number.
Medicare Part D
Medicare Part D offers prescription drug benefits, starting in 2006. This new program allows Medicare beneficiaries aged 65 and over, or those who are disabled, to enroll in a stand-alone prescription drug plan offered by private-sector entities. Participation in a plan is voluntary, not automatic, and so a person does not get automatically enrolled (unless the person is already receiving Medicaid). There is a monthly charge, except for participants who meet financial need tests. Each year eligible persons can change plans, or decide to start/stop their enrollment. However, the law includes penalties for late enrollment. For more information on Medicare Part D, including drug care providers, you can visit www.medicare.gov.